Making a
Difference
Award
20th Annivesar y (199
rating our
7-2016
)
Celeb
NOMINATION FORM (Please return by February 19, 2016, instructions on back)
Nominator
Name:
Circle One: Mr./Mrs./Miss/Ms.
Address:
City, State, ZIP, County (Hudson, Bergen, Morris, etc):
Telephone/Fax:
Cell Phone:
Title:
Occupation:
Business Address:
City, State, ZIP:
Telephone/Fax:
E-mail:
How did you learn about the Berrie Award?
A Past Recipient:
Facebook:
Internet:
Twitter:
Direct Mail:
Newspaper:
Radio:
E-mail Outreach:
Linked In:
Other:
Person Nominated
Name:
Circle One: Mr./Mrs./Miss/Ms.
Address:
City, State, ZIP, County (Hudson, Bergen, Morris, etc):
Telephone/Fax:
Cell Phone:
Title:
Occupation:
Business Address:
City, State, ZIP:
(Continued on back)
NOMINATION FORM
Making a
Difference
Award
rating our
Celeb
20th Annivesar y (199
7-2016
)
Please return form
postmarked no later
than February 19, 2016 to:
The Russ Berrie
Making a Difference Award
c/o Dr. Peter P. Mercer, President
Ramapo College of New Jersey
505 Ramapo Valley Road
Mahwah, New Jersey
07430-1623
Or submit online at:
berrieawards.ramapo.edu
Or E-mail:
madaawards@ramapo.edu
Or fax to:
201.684.7950
Please limit attached
supplementary materials
(such as press clips) to
no more than six pages.
This allows stronger
consideration of your
nomination.
Person Nominated cont.
Telephone/Fax:
E-mail:
Date/Time Period “unsung hero” made a difference:
Can we contact the nominee if additional information is required?
To the best of your knowledge, has this person previously been nominated?
How many years have you known the nominee, and in what capacity?
Please type or print clearly:
In 200-400 words, describe the reason for this nomination. Please be sure to describe the actions
that warrant the nomination and tell us in what way the person is an “unsung hero.”
Please comment on the following in your response:
1. The contribution this person made to society and what impact it made.
2. The outstanding, uncommon and unique qualities, skills and abilities that make this
person an “unsung hero.”
3. The nominee must live in New Jersey and have performed their good deed in New Jersey.
If the reason for this nomination is community service, please comment on the person’s
vision, leadership abilities, creativity and initiative for what they are seeking to accomplish.
If the reason for the nomination is a single act of heroism, please comment on the person’s
initiative, motivation and degree of risk involved in the act.
I have attached
pages
of supporting materials to
this nomination form.
Providing your e-mail address allows us to keep you informed about upcoming events.